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Spike in People Dying at Home, suggesting COVID-19 deaths are higher than reported: ProPublica; this tells us we need to find out who is going to die and isolate them before they get sick.

2020-04-15

death tombstone by Stefan Keller courtesy of pixabay.com

ProPublica reported on April 14 a dramatic increase in deaths at home, especially in cities like Detroit and New York and more so in low-income areas.  Detroit has seen a four-fold increase in home deaths and New York has had six times as many as compared to a year ago.  At the same time, overall mortality (death) rates have increased.  Some people may be dying at home from other diseases, afraid to contact medical help because of the risk of contracting COVID-19 from interactions with the health system.  Others are dying with the virus because they were told to shelter in place or because their disease overtook them before they had an opportunity to seek help.

Overall increases in death rates suggest that it is the latter: people are dying from the virus because they didn’t seek help or were told not to come in.  The death rate statistics lag behind the rapidly enlarging case counts for two reasons: one, it usually (but not always) takes up to two weeks to die after falling ill, and two, statistics are collected more slowly for deaths, particularly at home.

New York City, among the first to report “data on at-home deaths”, reported last week that about 200 people a day are dying at home or elsewhere outside of a hospital.  This compares to an average of 35 a day over the last four years.  Middlesex, Massachusetts (of which Cambridge is the best-known city) “reported 317 at-home deaths in March”, a 20% increase over the three-year average.  In late February, a conference in neighboring Boston was held that was afterwards linked to more than 100 infections.

This information feeds into a general impression that death statistics for the new virus are an undercount.  Many dead people are never tested for SARS-COV-2 because of lack of materials, despite the need to protect autopsy personnel, funeral home workers, and first responders from exposure to corpses that probably are teeming with secreted virus.

The deaths reflect the fact that people 65 and older are at high risk of dying from the new virus.  For Massachusetts in March, elder deaths increased by 3.6%, translating to an additional 250 deaths for the state.  This leaves out the first two weeks in April, a period during which cases skyrocketed in Massachusetts.  The additional deaths make clear that the count of 89 deaths from the virus in the state in March is surely a gross undercount.  “As of Monday, Massachusetts’ official COVID-related death count [for April] was more than 840.”

In Detroit, there were 150 “dead person observed” reports “in the first ten days in April”.  The average over the last 3 years was 40.  Almost all such incidents this year were in areas of low median income, places especially targeted by the virus.  In other areas, 911 calls have dropped; in Seattle, “EMT… calls dropped by more than 25% in the first ten days of April compared … [to] … last year.”  We don’t know whether emergency calls decreased because people were afraid of contact with other patients or providers with the virus.

The CDC says that death certificates can show “probable” or “presumed” COVID-19 on death certificates if the symptoms prior to death are compatible, even if the patient wasn’t tested for the virus.  However, official death tolls mainly “haven’t included people who died before they were confirmed positive.”

Complete death counts will take weeks to compile because of staff shortages and/or aged computers; for California, detailed figures on deaths for the whole state will take a month to obtain and ProPublica will pay $325 for the report.  In Hawaii, public health record “processing” has been stopped temporarily.

These at-home deaths show that the numbers we see on TV, even from the Johns Hopkins web site (which is the best), are only “the tip of the iceberg”.  We should be very concerned, and we should redouble our efforts to find out why certain people get terribly sick from this virus.  The best way to reduce the effects of the pandemic is to find out ahead of time who is going to go into critical condition after infection with SARS-COV-2.  Then we can isolate those most at risk and start releasing the rest from their self-imposed “social distancing” and stay-at-home orders.

 

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